e-Library of Evidence for Nutrition Actions (eLENA)

Intermittent iron and folic acid supplementation in adult women and adolescent girls

It is estimated that more than 30% of women of reproductive age worldwide are anaemic. At least half of this anaemia burden is assumed to be due to iron deficiency. Because women of reproductive age lose iron through menstruation and their diets are often lacking in available iron, they are particularly vulnerable to iron deficiency.

Daily supplementation with iron and folic acid for a period of 3 months has been the standard approach for the prevention and treatment of iron deficiency anaemia among women of reproductive age. Despite its proven efficacy, there has been limited success with the daily regimen public health programmes, which is thought to be primarily due to low coverage rates, insufficient tablet distribution and low adherence.

Recent evidence suggests that iron and folic acid supplements consumed once, twice or three times a week on non-consecutive days by all women of reproductive age are an effective, safe and more acceptable alternative to daily iron supplements.

WHO recommendations

In populations where the prevalence of anaemia among nonpregnant women of reproductive age is 20% or higher, intermittent iron and folic acid supplementation is recommended as a public health intervention in menstruating women, to improve their haemoglobin concentrations and iron status and reduce the risk of anaemia.


Additional information for this recommendation, including a suggested scheme for supplementation, can be found in the guidance summary and in the guideline, under 'WHO documents' below.

This is one of several WHO recommendations on iron and folic acid supplementation. The full set of recommendations can be found in 'Full set of recommendations'.

WHO documents

WHO documents

GRC-approved guidelines


Systematic reviews used to develop the guidelines
Clinical trials

Last update:

8 November 2016 15:41 CET

Category 1 intervention

Guidelines have been recently approved by the WHO Guidelines Review Committee

Essential Nutrition Actions

This intervention is an Essential Nutrition Action targeting the first 1000 days of life.

Global targets

Implementation of this intervention may contribute to the achievement of the following targets:

Global nutrition targets

Target 2: 50% reduction of anaemia in women of reproductive age